Provider Demographics
NPI:1780646323
Name:VAN SLOOTEN, PAUL HERMAN (MSW)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:HERMAN
Last Name:VAN SLOOTEN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MEMBERS WAY
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-5933
Mailing Address - Country:US
Mailing Address - Phone:603-740-2307
Mailing Address - Fax:603-609-6924
Practice Address - Street 1:789 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2526
Practice Address - Country:US
Practice Address - Phone:603-740-2307
Practice Address - Fax:603-609-6924
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH551041C0700X
MELC12691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1780646323Medicaid
NH3074625Medicaid
ME1780646323Medicaid
NH3074625Medicaid